We Need To Talk About The $40 Billion Dollar Reason Why Addiction Treatment Keeps Failing

The last post laid out why most addiction treatment doesn’t work, not because people don’t try, but because the system is built on flawed models. We are confusing compliance with healing

Here’s the root cause of that failure, the revolving door is financially profitable

The value of the addiction treatment sector is significant. High relapse rates, up to 50-70% within a year after many programmes (Kelly et al., 2020), which look like a failure on paper, are often an inherent feature of the business model

Re-admissions sustain the industry

This is not a conspiracy, it is the natural, ugly consequence of a profit-driven system built around symptom management, not root-cause resolution

Think about what drives a system that prioritises short-term, 30-day stays and abstinence-only metrics

The need for quick fixes – deep, trauma-informed, nervous system work is slow, nuanced, and intensive. It doesn’t fit neatly into an insurance or funding billing cycle, or a rapid detox timeline. Instead, we get models that address the addiction as a primary behaviour, completely bypassing the trauma history that is present in over 70% of clients (SAMHSA, 2022)

Avoiding true healing: Acknowledging the role of systemic trauma and nervous system dysregulation means completely redesigning the model, something most large institutions won’t do if the current model is solvent.

The emphasis on ‘powerlessness’ in many models can actually re-traumatise people by mimicking the disempowerment of earlier life events (Pagano et al., 2018)

When the industry’s success is defined by filling beds and processing clients, its mission, lasting healing, is compromised

The Solution: Shift the value from compliance to coherence,..

Stop defining recovery by a negative, what the person isn’t doing (using substances)…and start defining it by a positive: what the person is building (safety, connection, self-regulation)

We have to shift the value proposition from brief, intensive crisis management to long-term, integrated, relational healing.

We must reward outcomes that reflect lasting safety, not just clean drug tests

This means prioritise safety and agency.

Integrate the body (Somatic Work): without somatic integration, we are missing the mechanism by which safety is recorded (van der Kolk, 2021).

Success must be measured by overall life quality, relational health, and nervous system resilience, moving beyond abstinence as the sole metric (Witkiewitz et al., 2021).

Until we change the way success is measured and funded, we will keep punishing people with a system that has a vested interest in their return.

The opposite of addiction is safety, and we cannot create safety in an unsafe or compromised economic environment.

If you could force one policy change today to shift the incentives from ‘repeat business’ to ‘lasting healing’ in this sector, what would it be?We need to talk about the $40 billion addiction treatment industry-because despite all the money, it keeps failing to truly help people heal.